Leave No One Behind is a call to listen and learn by putting people in the centre, asking them what they need and valuing the one in everyone. It is based on the belief that human beings come in different shapes and sizes and a single solution cannot meet their diverse needs. WASH services are mostly designed to meet the needs of the mainstream, dominant community. But what happens to those that are traditionally left behind … the last mile … adolescents, pregnant women, the elderly, people with disabilities, migrant workers, rag pickers, transgender people? How do they take care of their daily sanitation and hygiene needs? What are their challenges and aspirations? Do they have insights and suggestions to improve sanitation services?

The Kathmandu Declaration from the fifth South Asian inter-ministerial conference on sanitation (SACOSAN V) recognized the importance of “addressing diversity in service provision for infants, children, youth, adolescent girls, women, people with disabilities, chronically ill and elderly in rural area and people affected by poverty…” and committed to significant direct participation of these groups in SACOSAN VI, Dhaka and systematically thereafter. (Commitment X)

As part of the preparation for SACOSAN VI in Dhaka, the Freshwater Action Network South Asia (FANSA) and Water Supply and Sanitation Collaborative Council (WSSCC) organized a consultative process with marginalized groups in South Asia to listen to their sanitation and hygiene needs, challenges, hopes and aspirations, as well as their suggestions for improvement. Over 2700 adolescents, women, elderly people, persons with disabilities, sanitation workers, rag pickers and transgender people participated in 55 consultations organized with the support of 70 local partners across Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. Read the Leave No One Behind report for the key findings and watch the film to hear interviews with participants.

Across these 8 countries, this was the first time many of these groups were being consulted on their sanitation and hygiene needs, challenges and aspirations.

Here is what some of them said …

“My daughter does not go to school when she is menstruating because she is embarrassed and feels that the male teachers may not understand her. There is no counseling for girls in school to explain how to manage menstruation hygienically. Girls tend to change their sanitary materials infrequently because they are not aware of the risks and due to economic reasons. Some of them use the same cloth for one and a half days!” – Adiba Qureshi, Afghanistan

“Once I fell on my back while going to the toilet behind my house and dislocated my back bone. I have had pain ever since. Now, I tie a cloth around me and pass urine standing like a man does. What else can I do?”- 80-year old Yellemma ,Warangal, Telengana, India.

“I need a bathroom which has support I can hold on to, otherwise I will lose my balance. A one-inch wall will easily collapse if I fall on it. That is why I want a bathroom to suit my need.” – Suman, a wheel chair user, Ranchi, Jharkhand, India

“As part of our work we sweep, pick up garbage, clean drains and pick up dead animals. The dead animals smell real bad. We don’t get a mask, gloves or shoes to cover ourselves. If people can’t bear the dirty smell, imagine what we have to bear while picking up a dead dog.” – Shankar Mukhi, Sanitation worker, Saraikela, Jharkhand, India

“We do not know which washroom to go to – ladies’ or gents’? The moment we visit the ladies’ toilets, women are either scared or make fun of us. When we go to the men’s toilet, we are assaulted. I am now scared and avoid using public toilets.” – Jaya, Transwoman, Bangladesh

So, is it just a question of more taps and toilets? Would infrastructure alone help to change mindsets and eradicate stigma and discrimination that prevent transgender people, like Jaya, from using public toilets or adolescent girls like Adiba’s daughter from going to school when she has her periods?

In January 2016, twelve community representatives who had been a part of the consultative process participated in a plenary session at SACOSAN VI, Dhaka. They eloquently shared the sanitation and hygiene challenges and aspirations of their constituencies with the audience of Ministers and key decision makers of participating governments, practitioners, academics, civil society and private sector agencies. The Dhaka Declaration is a testimony to the influence this session had on policy makers.

The Leave No One Behind consultation process is an important, first step towards addressing equity and inclusion in sanitation and hygiene. However, we need to continue and deepen this process by creating more platforms for constructive dialogue, so that duty bearers can listen to the needs and aspirations of marginalized groups and include them in the design, delivery and management of sanitation services.

For, unless we put the last mile first and listen, they will continue to be left behind.

– Kamini Prakash is Technical Officer – Equality and Non-Discrimination with WSSCC’s newly set up India team